常规超声及超声造影对局灶性胸膜增厚病变的鉴别诊断价值

目的探讨常规超声及超声造影对局灶性胸膜增厚病变的鉴别诊断价值。 方法回顾性分析2016年1月至2021年12月在北京大学第三医院行常规超声及超声造影检查的胸膜增厚患者36例，所有患者均取得穿刺活检或手术病理。根据病理及临床随访结果将其分为良性组与恶性组，分析并比较2组患者的临床资料以及常规超声和超声造影特征，绘制ROC曲线计算常规超声及超声造影特征对胸膜增厚病变的鉴别诊断效能。 结果36例胸膜增厚病变中良性组与恶性组各18例，2组间的年龄、性别分布差异无统计学意义（P均＞0.05）。恶性组胸膜增厚病变累及的长度小于良性组，二者差异有统计学意义［（2.65±1.49）cm vs（5.36±2.98）cm，P=0.002］。超声造影结果显示，等-高增强主要见于恶性组（16/18，88.9%），低-无增强主要见于良性组（9/18，50%），2组差异有统计学意义（P=0.027）。胸膜增厚累及长度诊断胸膜增厚病变良恶性的ROC曲线下面积为0.804，最佳截断值为4.75 cm，等-高增强的ROC曲线下面积为0.694。2项指标相结合后联合因子诊断的ROC曲线下面积可达0.816，敏感度、特异度、准确性分别为99.4%、66.7%、80.0%，约登指数为1.611。 结论常规超声测量的病变最大长度及超声造影强化程度能够有效鉴别局灶性胸膜增厚病变的良恶性。二维超声联合超声造影能够有效提高胸膜增厚病变的鉴别诊断效能，为后续穿刺活检和诊断治疗提供更多有价值的信息。

Value of conventional ultrasonography and contrast-enhanced ultrasonography in differential diagnosis of focal pleural thickening lesions

ObjectiveTo assess the performance of conventional ultrasound (US) and contrast-enhanced ultrasonography (CEUS) in the differential diagnosis of focal pleural thickening lesions. MethodsBetween January 2016 and December 2021, patients with focal pleural thickening who were referred for surgery or biopsy at Peking University Third Hospital were included. All patients were divided into either a benign group or a malignant group according to the results of pathology and clinical follow-up. The diagnostic results of the two methods and the clinical data of patients in the two groups were compared. Receiver operating characteristics (ROC) curve analysis was performed to calculate the differential diagnosis efficiency of the two methods. ResultsThirty-six patients were ultimately included. Based on histopathological results, the lesions were classified into two groups: benign (n=18) and malignant lesions (n=18). Age and gender did not differ significantly between the two groups (P＞0.05). The length of pleural thickening lesions in the malignant group was significantly shorter than that in the benign group [(2.65±1.49) cm vs (5.36±2.98) cm, P=0.002]. CEUS results also showed a statistically significant difference (P=0.027) between the two groups: iso-high enhancement mainly occurred in the malignant group (16/18, 88.9%), while low-no enhancement mainly occurred in the benign group (9/18, 50%). The area under the ROC curve (AUC) of the length of pleural thickening was 0.804, and the optimal cut-off value was 4.75. The AUC of iso-high enhancement was 0.694. The AUC of the two indicators (length and enhancement) combined reached up to 0.816. The sensitivity, specificity, and accuracy were 99.4%, 66.7%, and 80.0% respectively, and the Youden index was 1.611. ConclusionUsing the maximum length of the lesion on US and the degree of enhancement on CEUS, we can effectively distinguish benign and malignant lesions of focal pleural thickening. The combined use of the two methods not only improves the efficiency of diagnosis, but also provides more valuable information for subsequent needle biopsy, clinical diagnosis, and medical treatment.